目的 探讨心脏外科体外循环术后留置心外膜临时起搏导线的康复经验。 方法 选取 2015 年 9 月至 2016 年 4 月 69 例体外循环术后留置心外膜临时起搏导线患者，其中男 26 例、女 43 例，平均年龄（50.2±11.5）岁。予术前及术后干预措施、出院指导和随访，评价康复效果。 结果 患者术后平均住院时间（9.8±2.6）d，69 例患者均顺利出院，其中 57 例患者顺利拔除心外膜临时起搏器导线，1 例患者因Ⅲ度房室传导阻滞继续留置临时起搏器电极，11 例患者残留临时起搏导线出院，出院后两周随访发现 2 例患者的临时起搏导线体内残端露出体表。 结论 心外膜临时起搏电极是心脏外科术后常见的风险防范手段之一，掌握临时起搏器导线的管理及临时起搏器应用的相关知识，合理管理能有效地降低术后并发症的发生，可促进患者术后康复。做好患者宣教，避免因沟通不畅导致的医患纠纷发生。
ObjectiveTo investigate the effects of rehabilitation exercise on exercise tolerance and cardiovascular risk factors in patients with non-acute coronary syndrome (non-ACS) after interventional therapy.MethodsA total of 102 patients with coronary heart disease and non-ACS in our hospital from December 2018 to June 2019 were selected and randomly divided into a control group (n=51, 30 males and 21 females with an average age of 56.1±4.8 years) and a trial group (n=51, 34 males and 17 females with an average age of 55.1±4.9 years). The control group received routine treatment, while the trial group received regular supervised rehabilitation exercise on the basis of routine treatment. Patients were followed up for 6 months to compare the differences in cardiovascular risk factors (blood pressure, blood lipid, fasting blood glucose), 6-minute walking distance (6MWD), adverse lifestyle changes and treatment compliance between the two groups after treatment.ResultsThe difference of 6MWD between the two groups was statistically significant (P<0.05). In the trial group, 6MWD increased after intervention compared with that before intervention, and the difference was statistically significant (P<0.05). Comparison of total cholesterol (TC), high density liptein cholesterol (HDL-C), low density liptein cholesterol (LDL-C) and fasting blood glucose in the trial group before and after intervention showed statistically significant differences (P<0.05). The differences in TC, HDL-C and LDL-C in the control group before and after intervention were statistically significant (P<0.05). It was statistically significant in dietary compliance rate, smoking cessation rate and alcohol cessation rate between the two groups (P<0.05); the differences in the dietary compliance and drug compliance of the trial group before and after intervention were statistically significant (P<0.05).ConclusionRegular supervised rehabilitation exercise can significantly improve the exercise tolerance and cardiovascular risk factors of non-ACS patients after coronary intervention treatment, so as to improve the quality of life and long-term prognosis of non-ACS patients, which is worthy of clinical application.
Objective To compare the effect and degree of satisfaction of different analgesic interventions for tubes of pericardium and mediastinum removal after cardiac surgery. Methods From December 2017 to June 2018, 94 patients undergoing open heart cardiac surgery with tubes of pericardium and mediastinum were allocated randomly into three groups including a group A (32 patients), a group B (35 patients), and a group C (27 patients). In the group A, intravenous Dezocine was given as analgesics. In the group B, intravenous Dezocine plus oral ibuprofen were given. In the group C, interventions of group B plus specific nursing guidance were given. With the help of visual analogue scale (VAS), scores of pain during and after the tubes removal were collected. The degree of satisfaction and other adverse effects were also recorded. Results The VAS scores and fading time of pain in the group B were significantly lower than those of the group A (P<0.017). The score of sleeping was better in the group B as well. The VAS scores and fading time of pain in the group C were also significantly lower than those of the group A, and the scores of mood, activity as well as degree of satisfaction were all higher than those in the group A (P<0.017). The scores of activity and degree of satisfaction in the group C were higher compared with the group B (P<0.017). Conclusion Combination of intravenous Dezocine and oral ibuprofen seems to be more effective than each individual. Professional and specific nursing guidance could increase the degree of satisfaction for chest tube removal after cardiac surgery.
ObjectiveTo observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats, and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch. MethodsA total of 80 SD rats were randomly divided into normal control group (n=8), hernia model control group (n=8), patch implantation blank control group, and hernia model patch repair group. Eight rats were randomly selected at week 1, 4, 8, and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group. The normal peritoneum and surrounding tissues were taken from the normal control group, and the peritoneal tissues near the incision were taken from the hernia model control group, patch implantation blank control group, and the hernia model patch repair group. The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum. The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared. Results① Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue, which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group (P＜0.001, P=0.005) respectively, which at week 8 after patch implantation was alleviated (P=0.021) as compared to the 1st week after patch implantation in the patch implantation blank control group, which had no statistic difference between the patch implantation blank control group and normal control group (P=0.102), which at the 1st week after patch implantation was more severe than hernia model control group (P=0.014), which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group (P=0.040, P=0.040), which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ② Comparison of the degree of fiber hyperplasia in the peritoneal tissue, which at week 1, 4, and 12 after patch implantation was more severe (P＜0.001, P=0.003, P＜0.001, respectively) in the patch implantation blank control group as compared with the normal control group; which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group（P=0.017); which was more severe in the hernia model control group as compared with the normal control group (P=0.012); which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point (P>0.05); which had no obvious change between-time point in the hernia model patch repair group (P>0.05); which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ConclusionsBased on the experimental results of this study, hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue. However, during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach, extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function. But through the body itself repair, the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.